Provider Demographics
NPI:1316038649
Name:LAUER, MARILYN (RPT)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:LAUER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:BERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1864 JULIET AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3700 FOSS RD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55421-4512
Practice Address - Country:US
Practice Address - Phone:763-689-5385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP45800OtherHEALTH PARTNERS
MN6404435OtherMEDICA
MN397L1BEOtherBCBS
MN246533Medicare ID - Type UnspecifiedHDR